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When you say that you are depressed. . .

When you say that you are depressed, I have no idea what you mean. Or, more accurately, I have too many ideas. There is, of course, a definition of Major Depressive Disorder, published in the DSM-5. But very few people come and sit in front of me and list off the ways that their current experience matches up with the criteria in that giant book.

So, when someone mentions that word, I am curious. What does this person mean by “depressed”? For many, it is about sadness that just won’t let up.

But for some, there is no sadness. Those people would be so grateful to feel anything, even sadness, because they are stuck in a cold white fog of nothingness.

For some there is physical pain and exhaustion that just gets worse when they try to keep on going anyway.

Some struggle with a sense of meaninglessness and futility, not only for themselves, but for the world.

Agitation and anxiety can be a major part of the experience that some call depression, especially when it happens in the middle of the night and prevents sleep.

And, sometimes people are mourning a loss. It can be a death that is too recent to be bearable, or a less clear and explainable kind of loss, like a failed dream, or a betrayal or a crisis of faith.

Any or all of these experiences can be called depression.

The current medical approach is to treat all of these things with medications that change the brain’s chemistry. But we have no evidence that this is one disease process that has one cure. It is a little like offering insulin to everyone who is overweight, because it helps some people (those with type 1 diabetes). If Insulin is what’s needed, it would be unethical not to provide it. But what if the patient actually needs thyroid replacement therapy?

There are people who find that antidepressants make a big positive difference. They are lucky, because they have the type of depression that matches up well with the medication the doctors have available. Doctors care about their patients, and want to do what’s best for them. But, the truth is that they can’t really do that while all of these different experiences are being labelled with the same name and offered the same treatment.

There are actually a lot of successful depression therapies out there. It takes time, though, to figure out which one (or what combination) is suitable for each person. And not all of them are available from a physician. We should all be very grateful for those physicians who are willing to stay with their patients, and keep trying different therapies, referrals and approaches until they see a real change. Sadly, not everyone gets this kind of support.

It is a cruel irony that people who are feeling depression, and therefore have a much harder time seeking help for themselves, have to keep on trying on their own to find the help they need.

Are you frustrated in your search for help? I’d be happy to talk with you and see if I can point you to some good resources.